Anatomical causes of difficult embryo transfer during in vitro fertilization

Larue, L; Keromnes, Gwenola; Massari, A.; Roche, Clémence; Bouret, Dominique; Cassuto, Nino Guy; Ayel, J.-P.

doi:10.1016/j.jgyn.2016.09.004

Cited by 8 publications

(8 citation statements)

References 14 publications

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“…The overall pregnancy rates obtained in the present study from TVUS-and TAUS-guided ET (42.1% vs. 30.5%) agreed with a large retrospective study (38% vs. 30%) conducted by Larue at al. (2017b).…”

Section: Discussionsupporting

confidence: 92%

“…Apart from the discomfort caused to patients by the requirement of having a full urinary bladder under TAUS and its associated problems ( Fanchin et al ., 1998 ; Lesny et al ., 1998 ; Karavani et al ., 2017 ), longer waiting times may also hinder the running of a busy clinic ( Bodri et al ., 2011 ). Moreover, uterus abnormalities such as endocervical crypts, tortuous cervical canals, marked uterine anteversion, and local causes such as isthmoceles, which may result in difficult transfers, can also be more easily analyzed and resolved under TVUS than TAUS guidance ( Larue et al ., 2017b ). However, care must be taken concerning the correct positioning the TV transducer, which must be consistent with the anteverted or retroverted position of the uterus.…”

Section: Discussionmentioning

confidence: 99%

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Efficacy of a modified transvaginal ultrasound-guided fresh embryo transfer procedure

Nakano¹,

Radaelli²,

Fujihara³

et al. 2022

JBRA Assisted Reproduction

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Objective To present a modified transvaginal ultrasound (TVUS) guided embryo transfer (ET) procedure and analyze its efficacy in comparison with conventional transabdominal ultrasound (TAUS) guided ET in an unselected population of Brazilian women. Methods This retrospective observational case-control study involved 447 fresh ET cycles, 221 guided by TVUS (Group 1), conducted between June 2016 and February 2019, and 226 by TAUS (Group 2), conducted between July 2012 and December 2015. Pregnancy rate was the main endpoint. Groups were compared using the Z test at a level of significance of 95% ( p ≤0.05). Results Patient age ranged from 21 and 48 years; mean age was 37.7 years in Group 1 and 38 years in Group 2. Overall, patients that underwent TVUS-guided fresh ET demonstrated significantly higher pregnancy rates than their counterparts that underwent TAUS-guided fresh ET ( p =0.0107). TVUS-guided fresh ET also yielded significantly higher pregnancy rates in the subgroups of women aged 36-39 years ( p =0.0037) and ≥ 40 years ( p =0.0025). However, no significant pregnancy rate difference was observed in women aged ≤ 35 years ( p =0.0905). Conclusions The results suggested that TVUS-guided fresh ET was at least as effective as TAUS-guided fresh ET in the studied sample. Pending further prospective studies to better ascertain the effect of TVUS-guided ET, the technique presented deserves consideration since it can offer better visualization, more comfort to patients, and requires only one operator, without negatively affecting pregnancy results.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Efficacy of a modified transvaginal ultrasound-guided fresh embryo transfer procedure

Nakano¹,

Radaelli²,

Fujihara³

et al. 2022

JBRA Assisted Reproduction

View full text Add to dashboard Cite

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“…Some studies have identified cervical stenosis and pronounced anteversions of the uterus as causes of DiT, leading to the suggestion that embryo transfer could be improved by performing a dilation before the transfer (5). To date, only one prospective study has been conducted to identify correlations between anatomical characteristics, based on morphological examinations (ultrasound and hysteroscopy), and the difficulty of embryo transfer (8). The investigators identified 5 main anatomical causes for DiT: crypts, marked anteversions, tortuous cervical canal, cervical spasms, and other individual abnormalities.…”

Section: Discussionmentioning

confidence: 99%

“…It was considered a DiT in all other cases. If the transfer was difficult, the catheter was removed and a more detailed vaginal ultrasound was performed to analyze the anatomical characteristics of the patient and search for the most common anomalies: endocervical crypts, tortuous cervical canal, marked uterine anteversions, and cesarean-induced isthmoceles (8), or other causes (stenosis of the external or internal os, false passages, malformations, anomalies resulting from conizations, cervical endometriosis, and poor cervical exposure). If necessary, the size of the speculum was adjusted to improve the cervical exposure, and dilation of the external os was performed in case of external cervical os stenosis.…”

Section: Assessment Of the Difficulty Of The Transfermentioning

confidence: 99%

Evaluation of a strategy for difficult embryo transfers from a prospective series of 2,046 transfers

et al. 2021

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Setting: A hospital fertility center in France. Patient(s): Data were collected on all embryo transfers conducted using the strategy between February 2014 and February 2020. Intervention(s): Anatomical characteristics that could cause DiT were identified by transvaginal ultrasound and the catheter was adapted accordingly. Transfer was guided by transvaginal ultrasound. After passage through the cervix, a rest period was introduced to allow any contractions to stop before embryo deposition in the uterus. Main Outcome Measure(s): The primary criterion was the percentage of pregnancies per transfer (P/T) after an easy transfer (EaT) or a DiT. The secondary criteria included the anatomical causes of DiT and the patients' levels of discomfort. Result(s): Of 2,046 transfers, 257 (12%) were DiTs: minor difficulties (n ¼ 152; 7.4%), major difficulties (n ¼ 96; 4.7%), very significant difficulties (n ¼ 7; 0.3%), or impossible (n ¼ 2; 0.1%). The most common causes of DiTs were endocervical crypts (54%), tortuous cervical canal (36%), and marked uterine anteversions (30%). Several causes were often responsible for DiTs. There was no statistically significant difference in the P/T between the EaTs (n ¼ 1,789, 41%) and all degrees of DiT (n ¼ 257, 37%). In addition, there was no statistically significant difference between the level of patient-reported discomfort in the EaT and DiT groups. Conclusion(s):This study demonstrated that an adapted embryo transfer strategy, monitored by transvaginal ultrasound, led to similar pregnancy rates regardless of whether the transfer was easy or difficult. (Fertil Steril Rep Ò 2021;2:43-9. Ó2020 by American Society for Reproductive Medicine.

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“…Recently, Larue et al. conducted an observational study to detect anatomical anomalies by assessing the cervix and uterus using TVS and rigid hysteroscopy [ 22 ]. They found that the most common anatomical characteristics associated with difficult ET were abnormal crypts in the cervical canal (86%) and tortuosity of the cervical canal (68%).…”

mentioning

confidence: 99%

Hysteroscopic cervical features associated with difficult embryo transfer in unselected patients undergoing in vitro fertilization

Huang

Lan

2022

Biomedical Journal

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Anatomical causes of difficult embryo transfer during in vitro fertilization

Cited by 8 publications

References 14 publications

Efficacy of a modified transvaginal ultrasound-guided fresh embryo transfer procedure

Efficacy of a modified transvaginal ultrasound-guided fresh embryo transfer procedure

Evaluation of a strategy for difficult embryo transfers from a prospective series of 2,046 transfers

Hysteroscopic cervical features associated with difficult embryo transfer in unselected patients undergoing in vitro fertilization

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